With the Supreme Court decision to uphold mandatory health insurance purchasing under the Affordable Care Act, it's going to get more expensive. But for thousands of years people were able to go into the woods and get health care for free, so all is not lost. Maybe they can even get a rebate for using nature.

Natural remedies may not be as effective as their synthetic pharmacological cousins but a Harvard post-doc says there may be economic benefits people could receive by relying on such traditional cures.  If that feels like 'ketchup is a vegetable' sweet lemons rationalization, you are not alone.

In northwest Madagascar, says Christopher Golden, people annually receive between $5 and $8 in benefits by using natural medicines. Though small, that adds up to between $30 and $45 per household, which is anywhere from 43 to 63 percent of the median annual income for families in the region. It's an impact that may not be limited to Madagascar, or other regions where access to pharmaceuticals is limited.

As part of his analysis, Golden also compared the use of natural remedies with the prices that American consumers might pay if they were purchasing the pharmaceutical equivalent online – where prices are typically lower than on pharmacy shelves. To his surprise, the results showed that the average American could save anywhere from 22 to 63 percent of their annual health care bill, simply by using natural medicines.

"If Americans were relying on traditional medicines as much as people in Madagascar, it could save them a major percentage of their health care expenditures," Golden said.  That is going to be an interesting marketing campaign for poor people.  Like throwing parties to recruit more people into the Food Stamp program.

The paper only examined the economics of the natural remedies versus pharmaceuticals, not whether they were equally effective.  "What we're trying to do is account for the economic value the local floral bio-diversity provides to people in this area of Madagascar," Golden said. "We're not assuming there is a medical equivalency – this study is about the perceived efficacy. The people who live in this region often have taken both pharmaceuticals and traditional medicines many times, but there is a perceived efficacy for these traditional medicines." 

Measuring that perceived efficacy involved surveying 1,200 households in and around Maroantsetra, a city in the northeast corner of the island nation, to determine which natural medicines they used.

To establish the economic benefit of each natural remedy, Golden asked whether people would prefer to use the natural or pharmaceutical remedy for a given illness. If, for example, 60 percent of those asked said they preferred the traditional medicine, Golden established its value as being 60 percent of the price of its pharmaceutical cousin.

"Certainly, because there's no proof of medical equivalency between these treatments, it could easily be an over-estimation to establish these values," Golden said. "But the bio-diversity in these regions represents a huge pharmacopeia, and there are many hidden benefits to the use of these sorts of traditional medicines. These medicines aren't being improperly prescribed or mismanaged, and because they've been used for millennia, we know they're not producing any type of negative side effects."

The economic benefits offered by natural medicines, however, may not end at those who rely on them to treat day-to-day ailments.  The corner of Madagascar that Golden studied contains nearly one percent of all the global floral biodiversity, meaning the chance that a novel pharmaceutical might be developed based on the traditional medicines used in the area is relatively high. The value of that drug could range from $300 million to as much as $5.7 billion. 

"That raises additional issues, about who benefits from the discovery of these drugs," Golden said. "In the case of the Madagascar Periwinkle, which was used to develop the treatment for childhood leukemia, a foreign drug company came, took the plants to a foreign lab and they are now making billions, but not five cents has made its way back to Madagascar."

Citation: Golden CD, Rasolofoniaina BJR, Anjaranirina EJG, Nicolas L, Ravaoliny L, et al. (2012) Rainforest Pharmacopeia in Madagascar Provides High Value for Current Local and Prospective Global Uses. PLoS ONE 7(7): e41221. doi:10.1371/journal.pone.0041221